2019 OPEN ENROLLMENT ENDS (most states)

For any tech geeks like me out there curious as to how the original HC.gov website mess happened, this gives you an idea of how crazy the project became...

Healthcare.gov faltered last fall in large part because it was built by a crowd of uncoordinated contractors with no one in charge of making sure all the interlocking pieces fit together.

As the White House tries to prevent a repeat catastrophe, government watchdogs are investigating why the Obamacare marketplace failed in the two months after it opened on Oct. 1, 2013. A new report (PDF) details the 60 separate government contracts, awarded to 33 companies, that contributed to building healthcare.gov. The chart above shows how much each contractor was awarded."

Of course, the Obama Administration also sent in an "Apollo 13" emergency tech wizard team to clean up the mess and salvage the project in November, and the rest is history, but it's still important to understand how the federal exchange came so close to failure in the first place...

A little-known Obamacare tax on health insurance executives' salaries raised $72 million in new revenue last year.

For decades now, the United States has limited the corporation tax deduction for executive pay to $1 million for the company's top four employees. That deduction cap, however, excluded performance bonuses, creating a massive loophole allowing companies to pay their top employees more than $1 million without facing a higher tax burden.

Obamacare quietly changed the rules for health insurance executives. It lowered the cap to $500,000 — and, in that amount, now includes all forms of compensation. The health insurers' regulation also widens the scope of who it hits: while the general deduction cap only applies to the company's top four employees, the Obamacare rule hits any executive earnings more than $500,000.

These new limits kicked in last year. The Institute for Policy Studies ran the numbers and found that this one change resulted in the 10 largest insurers paying an additional $72 million in taxes in 2013.

INDIANAPOLIS (AP) — Indiana residents will have more than triple the number of health insurance plans to choose from when the federal insurance exchange enrollment period starts in November, according to a state official.

Indiana Department of Insurance attorney Tina Korty told a legislative panel Thursday that some insurers took a “wait-and-see” approach during the first year of the exchanges under the Affordable Care Act.

Nine companies will offer a total of 975 plans - not all will be available in every county - for Indiana residents on the federal exchange, she said. During the 2013-14 period, three companies offered 278 plans, The Times of Munster and the Post-Tribune reported.

“I think a lot of companies were waiting to see how the first year went,” Korty said. “Also were seeing some smaller providers that may offer a policy in only a few counties.”

Korty said a 5 percent average increase in exchange premiums is expected on Indiana policies.

A worrisome trend is emerging among some Californians who thought they were safe and secure under Covered California: Their plans are being canceled without consent and sometimes without notice.

...A growing number of Californians with Covered California plans are learning – sometimes through happenstance – that their plans no longer exist. Some, like Manahan, are getting shunted into Medi-Cal. Others are dropped outright.

...Covered California acknowledges that it is yanking some people off of its plans and putting them on Medi-Cal, months after they signed up or submitted income information.

We’re “in the process of manually verifying the documents provided by individuals who were conditionally eligible for obtaining health care coverage through our agency,” says Covered California spokesman James Scullary. “Through that process, some customers will receive notices indicating they are now eligible for no-cost or low-cost Medi-Cal coverage.”

If my calculations are correct, the total number of ACA exchange-based QHP enrollments should now be at around 9.2 million...and the number of people who have paid for their first month's premium should have finally crossed the 8 Million milestone right around...now (plus or minus a week or so).

A few days ago, news broke that Pennsylvania's Governor Tom Corbett, whose re-election numbers are in the toilet and who is desperate to get Pennsylvanians to like him, has finally agreed to the Medicaid expansion provision in the Affordable Care Act.

While "doing a single decent, human thing after a couple of years of being a jerk about it" shouldn't really count as being praiseworthy, I suppose he deserves at least a small golf clap, just as Michigan Gov. Rick Snyder and Ohio Gov. John Kasich did.

In a move that could mean health coverage for thousands of Tennesseans, Gov. Bill Haslam said Thursday that the state may soon submit a proposal to Washington to expand Tennessee's Medicaid program but did not release any new details on how it might work.

Florida’s Obamacare enrollment is now over 220,000 lower than the Obama administration’s most recent tally, according to a report from the state insurance department.

The Obama administration hasn’t released updated Obamacare enrollment statistics since May, when the Department of Health and Human Services put the number of Florida sign-ups at 983,775 — but the Florida Office of Insurance Regulation says that now, just 762,723 Floridians have health insurance through the exchange.

OK, stop right there. Yes, it's true that the most-recent HHS report had enrollments at 983,775, but that was as of April 19th, not "May". Minor error, I agree, but important in the context of what we're talking about there. OK, go on...

The Maryland Health Connection just issued their latest monthly enrollment report (running from 7/27 - 8/23). On the one hand, the QHP tally includes both new additions and dropped/cancelled enrollments this time around, making it useless for adding to my off-season enrollment projection chart...

Enrollment Data
As of August 23, 78,666 individuals have enrolled in qualified health plans.1

As of August 27, 2014, 355,281 individuals have gained Medicaid coverage in 2014 and remain active in Medicaid. This includes the 95,889 PAC enrollees who were automatically converted on January 1, 2014 to full Medicaid coverage. We have begun reporting the net changes in Medicaid enrollment. This figure takes into account that individuals lose Medicaid coverage because of changes in household, age and income, as well as redeterminations. Compared to December 31, 2013, the net change in Medicaid enrollment as of August 27, 2014 is +262,737.

A little while ago I posted about the failed Florida "Health Choices" website, the Florida GOP response to the Affordable Care Act. Over a 6 month period, they've only managed to enroll 30 people, total. That's Three-Zero.

So, how does this compare to the cost-per-enrollee of other "failed" Obamacare exchanges?

Well, Healthcare.Gov itself, which enrolled over 5.4 million people and covers 36 states, spent $647 per enrollee.

Nevada's ACA exchange was botched by Xerox to the tune of $51 million, and enrolled 38,000, or $1,342 apiece.

Maryland spent $118 million and had enrolled 78,930 people in private plans as of the end of June. That's $1,495 per person.

TALLAHASSEE — Last year, legislators allocated $900,000 to help Floridians find affordable health care through a new state-backed website.

At the same time, they refused to expand Medicaid or work with the federal government to offer subsidized insurance plans.

Six months after the launch of the state's effort, called Florida Health Choices (floridahealthchoices.net), just 30 people have signed up. Another seven plans were canceled either because consumers changed their minds or didn't pay for services.

Huh. OK, exactly 1 day after I snarkily speculated that Cover Oregon is unlikely to release an enrollment update anytime soon due to their increasingly-ugly legal (and technical) battles with Oracle Corp., take a guess what just happened this morning...

Sarah Kliff at Vox broke the news a few hours ago, but I just received the official press release from CMS; there seems to be some discrepancy about the total number eligible, but it's fantastic news no matter what:

Well, an ACASignups supporter named Jim Stuart (all I really know about him is that he's a retired executive and educator who attended Princeton and lives in Illinois) has gone even deeper into the weeds on this and, well, I'll let those who know more about such things than I do decide how much of a Big Deal this is.

With Jim's request/permission, I'm reposting his piece verbatim, but I'd also advise checking out his own blog.

But Askew is in a tiny minority. Only 2 percent of all eligible businesses have checked out so-called SHOP (Small Business Health Options Program) exchanges in the 15 states where they have been available since last October under the Affordable Care Act. Even fewer purchased policies.

The good news is that things should start ramping up on the SHOP side this fall:

In November, three more state-run SHOP exchanges are slated to open, and the federal government will unveil exchanges for the 32 states that chose not to run their own.

In spite of their amazingly successful manual workaround process (which has enrolled 465,000 people in either private or Medicaid coverage), Oregon's website debacle continues to fester. Even so, until recently they've ironically been one of the most reliable state exchanges when it comes to publicly posting updated enrollment data. New detailed data has been posted pretty much once a week since the crazy days of March/April on a regular basis.

That all came to a screeching halt just over 3 weeks ago; the last update out of CoverOregon was August 6th. Again, this is still much better than most other states which only publish updates monthly or not at all, but for Oregon it's been worrisome for me, since they're one of only a handful of states giving that info out at all during the off-season.

The big news ACA yesterday was that Kevin Counihan, the guy who ran AccessHealthCT (one of the best-run state exchanges) has left that post to become the new "CEO" of Healthcare.Gov, just in time to prepare things for the 2nd open enrollment period.

By all accounts, this is excellent news all around. Counihan has been widely praised for his work in Connecticut--as well as in Massachusetts prior to that (he was one of the guys in charge of the original "RomneyCare" initiative).

So. We now have a new HHS Secretary (Sylvia Burwell, who's been in charge since early summer), a new Healthcare.Gov CEO (the first, actually), and a new Communications Director for CMS (Centers for Medicare & Medicaid Services), Lori Lodes.

Beneficiaries with Healthy Michigan Plan Coverage: 373,171
(Includes beneficiaries enrolled in health plans and beneficiaries not required to enroll in a health plan.)

*Statistics as of August 25, 2014
*Updated every Monday at 3 p.m.

Oh, and by the way, while Michigan Governor Rick Snyder may deserve some credit for pushing his party to accept Medicaid expansion, this was only possible due to THE AFFORDABLE CARE ACT, AKA "OBAMACARE".

Amazing how many people can't seem to get that through their skulls, even as they heap praise on the Governor for basically "not being a jerk" in this instance. Apparently "not being a jerk" on one issue is worthy of high praise when it comes to Republican elected officials these days.

A few days ago, David Ramsey of the Arkansas Times reported about a leaked document with the proposed & approved private QHP premium rate changes for 2015. At the time, he calculated the weighted average of the approved rates to be a drop of around 3.5% overall.

Today he reports that the official rate approvals have now come out, and while there was a slight error in the original numbers, the final weighted average is still excellent news: An overall weighted drop of 2%:

Insurance companies have proposed a net reduction in premiums of 2 percent next year for the Arkansas Health Insurance Marketplace, the health insurance exchange created by the Affordable Care Act. The Marketplace includes all of the plans used for the private option, the state's unique plan which uses Medicaid funds to purchase private health insurance for low-income Arkansans.

That "private Medicaid option" factor is important as well, because...

I posted something about this a few days ago, but it didn't get nearly as much buzz/attention as I would have figured, probably due to my soft-selling the headline. Anyway, Enroll America has released a report which estimates that there's up to 6.7 million people who could qualify to enroll in a new, ACA-compatible health insurance plan via HC.gov (or their state exchange, depending on where they live).

The current article focuses specifically on Texas, where up to 365,000 people should be eligible to enroll right now, even though it's the "off-season", due to major life changes such as recently getting married, divorced, having a child, losing their job and so on.

Round two of Obamacare enrollment starts Nov. 15. But a group promoting signups wants Texas’ 5 million uninsured adults between the ages of 18 and 64 to know that as many as 365,000 of them are eligible today to go online and enroll in the federally run health insurance marketplace.

The Washington State Insurance Commissioner just released a chart listing all of the companies operating on the exchange this fall (including 3 new ones, bringing the total to 12), how many plans they're each offering, the requested rate change and the approved ones for most of them.

Unfortunately, they don't include an actual enrollee breakdown, so I can't tell whether this is a weighted or unweighted average. Judging from the numbers provided, it looks like an unweighted average would be just 0.1%, so I'm guessing that the 1.9% mentioned in the press release is weighted, but I'd be more confident of this if they included how many people were enrolled by each company.

(h/t to Josh Z. for pointing out the uncertainty here)

In any event, the original average requested increase was 8.6% (4.8% unweighted), so this is still great news either way.

In addition, the total number of plans has doubled from 46 to 90:

90 health plans approved for next year’s Exchange with a record low 1.9 percent rate change – Exchange Board set to certify plans on Aug. 28

Fresh off a Philadelphia Fed survey of manufacturers finding that the Affordable Care Act is acting as a drag on hiring and increasing part-time employment, a Dallas Fed survey finds the much same thing.

Like the Philly Fed survey, it was tacked on to an existing monthly survey of conditions. In this case, a net 23.5% of respondents say the number of workers employed is lower due to the effects of what’s commonly called Obamacare. Part-time work is up, the amount of work outsourced is up, wages and salary compensation per worker is down, other benefits are down, and prices charged are higher.

OK, I'm feeling a bit foolish now. Earlier today I lamented the fact that the number of state exchanges issuing regular updates continues to dwindle. A few moments ago I realized that I hadn't checked in on Colorado in awhile, and sure enough, they've posted an update through the end of July.

No Medicaid numbers are included, but the exchange QHP tally has risen by another 3,750, to break the 140K milestone at 140,355.

The enrollment rate in CO has dropped a bit since earlier this summer, but they're still running pretty strong. With the new updates from CO and MN, my off-season enrollment projection has dropped a bit as well and now ranges between 8,100 - 10,900/day, still centered squarely on the 9,000/day mark.

Even in states whose ACA exchanges have operated pretty smoothly such as Connecticut and Kentucky, there's bound to be some technical problems. Washington State is no exception. As a result, the WA insurance commissioner has announced that anyone who tried to enroll earlier but has struggled with billing, payment or other technical issues (WA is one of only 2 states that run payments through the exchange and require the 1st months premium to be paid before even reporting the enrollment) can now give it another shot or make whatever changes are necessary without requiring a "qualifying life event" to do so:

The Washington Health Benefit Exchange (the Exchange), also known as the Washington Healthplanfinder, is making progress to correct the enrollment and payment difficulties that have affected some consumers. Those fixes are continuing, but may take additional time to resolve.

Yeah, yeah, I know the title is lame, but it's not easy to find alliterative synonyms for "ugly" and "unpleasant" starting with "O"...

Anyway, a few days after Oracle sued Oregon for $23 million in unpaid bills over the CoverOregon exchange debacle, the state has counter-sued the tech company...for a whopping $5.5 BILLION...including "Whoa...heavy, dude!" charges by the state Attorney General such as racketeering:

In the aftermath of what was likely the most spectacular failure among state-run Affordable Care Act health exchange site launches, the state of Oregon has filed a lawsuit against Oracle America Inc. over the total failure of the Cover Oregon exchange. “Oracle’s conduct amounts to a pattern of racketeering activity that has cost the State and Cover Oregon hundreds of millions of dollars,” Oregon Attorney General Ellen Rosenblum wrote in a civil complaint filed August 22. The lawsuit seeks over $5.5 billion in damages from Oracle, plus legal fees.

The complaint comes after Oracle filed its own lawsuit against the state’s health exchange for failure to pay for services rendered in early August. Oracle’s attorneys claimed that Oregon Governor John Kitzhaber had defamed the company in a “smear campaign” while failing to take responsibility for the failure of state management of the project and not paying Oracle for additional work done.

The Bad News: Up until recently I was only receiving regular upates from 3 states (plus monthly updates from Maryland and random, occasional updates from various other states). For the past few weeks, however, even 2 of those 3 states (Hawaii and Oregon) have seemingly gone radio silent as well. Aside from the next monthly MD update (due sometime this week, I believe), that leaves Minnesota as the sole state keeping their data up to date.

Meanwhile, Minnesota's exchange Medicaid total has now broken the 250K mark and stands at 250,557.

The news broke just a few hours ago that Kevin Counihan, the head of AccessHealthCT (Connecticut's extremely successful ACA exchange, which works so well that they were able to actually sell the software platform to Maryland to replace MD's original broken system) is leaving the CT exchange for an unspecified position at the HHS Dept:

Access Health CT CEO Kevin Counihan, who spearheaded Connecticut's largely successful first round of Obamacare enrollment through the state's public insurance exchange, is departing, a source close to the matter confirmed.

Access Health has scheduled a noon press conference Tuesday to make the announcement. No replacement will be named today, according to the source, who said Counihan is leaving to take a federal position within the U.S. Department of Health and Human Services.

Well, Sarah Kliff over at Vox.com has now broken the news about just what that new HHS position actually is...and it's very good news indeed:

Breaking: White House announces Kevin Counihan will be new Healthcare.gov CEO. Currently runs the Connecticut exchange.

States running their own Affordable Care Act marketplaces enrolled more people in health insurance than those using the federal marketplace, according to an analysis by researchers at the University of Pennsylvania's Leonard Davis Institute.

Given the federal Website's dreadful October launch, that isn't exactly jaw-dropping news. But Penn's Health Insurance Exchange researchers were surprised to find that even after Healthcare.gov began working well in December, state-based marketplaces kept outperforming the federal site.

Huh. Interesting. They even specified that this was true "even after December".

Of course, there's a very good reason why they would be "surprised" at this finding...it's not even remotely close to being true.

Regular followers of this site know that I'm primarily a bean counter, concerned mainly with tracking the numbers and plugging them into spreadsheets and graphs.

However, there's another side to the ACA story which is extremely important, and which I tend not to give enough attention to, and that's the human factor.

Sources like Amy Lynn Smith and ACASuccessStories have been doing their best to put a human face on what the Affordable Care Act means for real people with real healthcare needs, and I've mentioned or given a shout-out to these and other "tell your story" writers from time to time. However, it was 3 completely unrelated incidents which inspired me to write this entry.

Vermont signed a revised contract with the tech firm Optum that expands its role in Vermont Health Connect’s operations.

Optum already had a contract worth $5.6 million for consulting work, and the latest deal, signed Aug. 15, is worth an additional $9.5 million for a total of $15.1 million.

...At latest count, Optum has helped the state halve its backlog of coverage changes and information errors from a high of more than 14,000 to roughly 7,000. Also, close to 4,000 people are having billing issues with Vermont Health Connect. There is some overlap between the two groups, Miller said.

It’s hard work trying to get people to sign up for health insurance when their care is mostly free to them. Andrea Thomas is working to get Alaska Natives in Sitka, Alaska, to do just that. She’s the outreach and enrollment manager at SouthEast Alaska Regional Health Consortium (SEARHC), and it’s her job to sign people up for health insurance coverage through exchanges created as a result of the Affordable Care Act.

To get a sense of just how uphill Thomas’s battle is, consider this: Of the more than 100,000 people who live in Alaska and self-identify as Alaska Native or American Indian, only 115 had signed up for health insurance through an Affordable Care Act exchange as of March 31. Alaska Natives and American Indians are exempt from tax penalties for not signing up for health insurance.

(Baltimore) – Maryland Insurance Commissioner Therese M. Goldsmith today announced approved premium rates for individual health insurance plans to be offered in the State for coverage beginning January 1, 2015.

Premium rates for three of the six carriers currently participating in Maryland’s individual insurance market – All Savers Insurance Company, Evergreen Health Cooperative, and Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. − will drop by an average of 6.7 percent, 10.3 percent, and 14.1 percent, respectively. The other three carriers currently in the market, all CareFirst companies, received approval to increase premium rates by 9.8 percent (CareFirst BlueChoice, Inc.) or 16.2 percent (CareFirst of Maryland, Inc. and Group Hospitalization and Medical Services, Inc.), on average − substantial reductions from the 22.8 percent and 30.2 percent increases those companies requested for 2015.

About a year ago, Georgia Insurance Commissioner Ralph Hudgens bragged to a crowd of fellow Republicans: “Let me tell you what we’re doing [about ObamaCare]: Everything in our power to be an obstructionist.”

It was a striking quote that quickly took on national significance. As a rule, policymakers at least pretend to care about working constructively, but here was a state official boasting about his deliberate embrace of obstructionism.

And yet, this week, Hudgens said he didn’t really mean it.

“I spoke to a Republican group in Rome, Ga., and I said I was going to be an obstructionist, but I can’t be. I mean, I was talking to a Republican group and I was throwing them some red meat.”

OK, a couple of caveats here: First, yes, it's California; obviously this isn't exactly representative of states like, say, Oklahoma or Alabama. Second, CoveredCA had a much smoother rollout last fall than HC.gov did (and some of the other state exchanges are still struggling with serious technical issues).

Having said all that, California does still have over 12% of the total U.S. population, and they do tend to be early adopters historically. With that in mind...

The nation’s new health care law is surging in popularity in the Golden State, according to the Field Poll, which finds more Californians today — of all political stripes — support the Affordable Care Act than at any time since it was signed into law four years ago.

And by a two-to-one margin, they praise the successful way it’s been rolled out in the state, compared to the federal government’s glitch-ridden system.

Still more now say they’re satisfied with the way the health care system is working in the state, compared to a year ago.

Low-income consumers struggling to pay their Obamacare premiums may soon be able to get help from their local hospital or United Way.

Some hospitals in New York, Florida and Wisconsin are exploring ways to provide such aid, which would at least partly guarantee the hospitals get paid when the consumers seek care.

But the hospitals' efforts have set up a conflict with insurers, which worry such programs will add too many sick people to their rolls. The premium assistance could drive up costs for everyone and discourage healthier people from buying coverage, insurers wrote recently to the Obama administration.

Think about that one for a moment.

The hospitals (you know, the ones who are supposed to help heal the sick) are offering to help pay the insurance companies for patients who can't afford it otherwise...and the insurance companies are actually opposed to this...because it might add "too many sick people" to their customer base.

Thanks to contributor Mark N. for bringing my attention to this piece by Avik Roy (with whom regular readers know I've butted heads with on a number of occasions). Interestingly, he seems to have written this piece specifically for Politico, not for Forbes where his stuff can usually be found...although he did post a follow-up piece addressing (right-wing) criticisms of his plan at Forbes. Not sure of the significance of that.

Anyway, Mark gives a nice summary of the original article:

...the gist...is "keep Obamacare" and ditch Medicare. In other words, run the elderly through the Obamacare exchanges using premium support etc. but making the rich elderly pay their way. The average cost per month of a Medicare beneficiary is about $1000, I learned recently, which is not horrendous. I can't stand Avik. But this is the first thing he ever wrote that I can relate to. My 23 year old waitress daughter is paying taxes to support a bunch of elderly people who have 1000 times as much money as she does. You see my point.

Carriers have submitted proposed 2015 rates for the Arkansas Health Insurance Marketplace — the health care exchange created via the Affordable Care Act — to AID for review. According to information previously available online via the Arkansas Insurance Department, the news is good: if the proposed rates are approved, they will lead to an overall decrease in insurance rates on the Marketplace.

...Blue Cross Blue Shield, which currently has the largest market share on the marketplace, proposed a rate increase of zero...Celtic, selling in Arkansas as Ambetter, which currently has the second largest market share, proposed a rate decrease of 12 percent. Finally, QualChoice, which has the smallest market share, proposed a rate increase of 5 percent.

On the one hand, aside from a brief panic attack I had the week after Independence Day, I've consistently been confident that my 8,000 - 10,000/day estimate for off-season QHP enrollments is solid. With 7 months from 4/15 - 11/15, that's anywhere from 1.7 - 2.1 million people enrolling in exchange-based QHPs in addition to the 8.02 million who had done so as of mid-April.

On the other hand, even the minimal off-season data that I've been able to cobble together has nearly dried up in the past few weeks; only 4 states have been posting regular updates since April, and 2 of them (Hawaii and Oregon) haven't done so in several weeks as they overhaul/retool their websites. This leaves just Minnesota (with nearly daily updates, hooray!) and Maryland (which only released reports monthly, but has been reliable about doing so); pretty slim pickings of late, so it's reassuring to see that my claims are more than reasonable:

Almost 7 million people can sign up for health plans under ObamaCare even before the new enrollment period begins in November, according to an advocacy group.

Shades of John "OMG!! Papa Johns will be forced to raise prices by 14¢ a pizza!!" Schnatter in Chicago this week...

The Chicago Cubs denied an assertion by the Chicago Sun-Times on Friday that the tarp debacle earlier in the week against the San Francisco Giants happened because the club short-staffs the grounds crew at Wrigley Field in order to avoid paying health insurance.

The short version: The nasty storm last week ended up making Wrigley Field unusable because the grounds crew was shorthanded. According to the Sun-Times, the reason they were shorthanded is because the team management slashed their hours in order to avoid having to pay for (gasp! the horror!) healthcare coverage for the staff.

As writer David Brown notes, if true, this is pretty slimy behavior for two reasons:

If a grounds crew person needs to work at least 130 hours a month to meet the requirements for health care, that's the cost of doing business. But the Cubs have gone on the cheapsince being sold by Sam Zell, and it's not just in the free-agent market.

OK, technically this is only the 2nd separate entry under the "Invisible Hand Slaps!" moniker, but I've posted 5 updates to the original one and it started to get unwieldy, so I'm calling this "Part 7" instead:

UnitedHealth Group Inc. will apply to sell Obamacare plans in 24 states next year, vastly broadening the footprint of the nation’s largest insurer, which had stood largely on the sidelines during the law’s first year.

UnitedHealth UNH is expanding its reach sixfold, from just four states where it is participating in plans offered under theAffordable Care Act. The Minnetonka, Minn.-based insurer plans to offer coverage in such states as Florida, Louisiana, Michigan, North Carolina, Ohio, Pennsylvania and Texas.

This morning I received the following from a friend, regarding 2 Republican candidates for local/state office: Hugh Crawford (term-limited state representative, running for county commission...and hoping to swap places with his wife, who's currently a county commissioner running for his state rep seat) and Mike Kowall (state Senator running for re-election):

Last night was a candidates forum at Fox Run, the Novi retirement community. Candidates for the State House, State Senate, and County Commission were there. During the Q&A a question was raised whether the candidates supported Obamacare.

Both Hugh Crawford and Mike Kowall answered this way: "I don't like Obamacare, I would have voted against it, but I very much support Governor Snyder's Healthy Michigan Initiative, which brought the state over $400 Million in Federal Money."

It's no secret that I'm a progressive Democrat. It's also no secret that I live in the metro Detroit area (although I'm actually in MI-09, Sandy Levin's district, not MI-11). Obviously I'm a bit on the biased side when it comes to local Congressional races. All that said, MI-11 Republican candidate and foreclosure attorney David Trott (best known for kicking old ladies out of their homes) gave a newspaper interview recently which was jaw-droppingly full of nonsense when it comes to (among other subjects) the Affordable Care Act.

For starters, the question itself was disgustingly biased:

Many American families experienced sticker shock when the first monthly premium arrived for health insurance under the Affordable Care Act. Many also now have high deductibles that make them wary of getting medical care at all. What would you do too bring down costs and improve medical care?

...but Trott decided to one-up his interviewer in the gall department:

When I updated the Minnesota exchange numbers just a few days ago, they stood at 53,647 QHPs & 240,654 Medicaid/CHIP enrollees...or 294,301 total.

Just 3 days later, the MNsure exchange has tacked on almost 5,800 more people, breaking through the 300,000 mark:

More Than 300,000 Minnesotans Enroll in Quality Health Coverage Through MNsure

ST. PAUL, Minn.—MNsure today announced that 300,085 Minnesotans have enrolled in comprehensive, affordable health insurance coverage through the state health insurance marketplace.

“I’m proud to announce today that more than 300,000 Minnesotans have enrolled in health insurance through MNsure,” said MNsure CEO Scott Leitz. “During the State Fair, we hope to help even more Minnesotans find comprehensive, affordable coverage that meets the needs of their families or small businesses. Be sure to visit us in the Health Fair 11 building and bring your questions about MNsure.”

For those who assume Cover Oregon will go away when the federal government takes overthe state exchange's job of enrolling people in health coverage, think again.

Even as Oregon works on hooking up to the federal website by November, some Cover Oregon board members hope the engagement with Uncle Sam will be only a one-year affair.

I found one quote in particular to be a bit of an eyebrow-raiser:

But the idea is controversial on both sides of the political aisle in Salem.

"Hell, no," says Sen. Brian Boquist, R-Dallas. He thinks Oregon should leave the job to the federal exchange and Cover Oregon as a stand-alone agency should go away. "Cover Oregon, the whole structure is bad from beginning to end. I don't trust the federal government. But I do trust the federal government more than I do the state of Oregon."

The story itself is noteworthy mainly because it suggests that the ACA's individual mandate may be having a positive impact, as Wal-Mart reports that "far more" of their employees have enrolled in the company's healthcare program than they expected this year.

What strikes me, however, is how CNN Money is acting as though this is somehow a bad thing, since it "hits" their corporate profits for $500 million:

Wal-Mart Stores says far more of its workers are signing up for its health care coverage than it expected.

Because of that, the world's largest retailer will earn less in the current fiscal year than it had previously promised investors.

While the requirement that employers provide health coverage has yet to take effect under Obamacare, the requirement that individuals have coverage has prompted people to compare plans available to them at work with plans offered on government exchanges.

Interesting story (originally via Kaiser Health News) about a little-known provision of the Affordable Care Act which gives CMS (Centers for Medicare & Medicaid Services, a sub-section of the HHS Dept.) a $10 billion R&D/incubator budget over a decade to try out different methods for delivering healthcare and payments in a more efficient manner:

The law created the Center for Medicare and Medicaid Innovation to launch experiments in every state, changing the way doctors and hospitals are paid, building networks between caregivers and training them to intervene before chronic illness gets worse.

The center's 10-year, $10 billion budget is the largest ever devoted to transforming care. In several states the office is working to overhaul medicine for nearly all residents -- not just those with government Medicare and Medicaid coverage.

Still clearing out my in box, but I'm at least able to devote a full entry to each story this morning. This one is from more than a week ago but still very noteworthy:

One of the nation’s largest hospital operators,Tenet Healthcare THC -0.12% (THC), last week opened a window into the differences for patients and hospital financial coffers between those states with Medicaid dollars and those without.

“In our five states that expanded Medicaid in 2014, we benefited from a significant migration of patients from uninsured into Medicaid with a 54% decline in uninsured admissions and a 27% decline in uninsured outpatient visits,” Tenet chief executive Trevor Fetter said during the company’s second-quarter earnings call last week.

In case you think this is just "cherry-picking" from a single hospital corporation, here's a similar story from back in May (when Medicaid expansion enrollment was significantly lower):

Took me awhile to get to this story: Like Michigan, New Hampshire is a late addition to the ACA Medicaid Expansion club, having just started the program on July 1st. The initial number doesn't sound impressive until you realize that only 50,000 people are eligible for it in the state to begin with:

"It makes you happy to be able to offer people something," said Paula Smith, who as a counselor for the Affordable Care Act or Obamacare has had to tell some people that they have too much income for the new federal health-care marketplace.

..."We called her back and told her we could help her now," Smith said.

As of the end of the day Friday, Aug. 8, the state says 9,399 people have signed up for the New Hampshire Health Protection Program since enrollment began July 1. Actual coverage starts this Friday, Aug. 15.

New Hampshire officials have estimated that about 50,000 people the state are eligible for expanded benefits under Medicaid, the federal health program for people with lower incomes.

Idaho officials say they’re tired of waiting on files from the federal government and have figured out a way to transfer the state’s 76,000 Obamacare customers from the federal marketplace to its state-run portal this fall.

Your Health Idaho said it had hoped to leverage federal information to set up existing enrollees on their own web platform.

Instead, it has asked the state’s health and welfare agency to use its eligibility system to figure out who is eligible for government subsidies under the Affordable Care Act. It will also work with insurance carriers to determine who signed up for coverage and needs an account on the state exchange, which is set to launch in time for the overhaul’s second sign-up period on Nov. 15.

One of the big news stories in 2013 and early 2014 was the botched launch of the federal Exchange (and several key state Exchanges), which led to many Americans having to wait to be enrolled in an ACA-sanctioned health plan. Although some technical snafus have been addressed, many still remain. For example, a top White House official told Congress recently that the automated system to send payments to insurance companies is still under development, and didn't offer a completion date. The lack of an electronic verification process is only one part of the "backend" of the software that is still problematic five years after the Act was passed.

First in a series of profiles about KY women in charge of the state exchange:

Energy exudes from Carrie Banahan when she talks about her work with others to bring affordable health care to more than half a million Kentuckians.

“I worked all my life to see this happen, that we can provide affordable health insurance to people, and it has actually happened,” she said. “I am thrilled that we are actually helping people in Kentucky. It is the highlight of my career.”

Banahan is executive director of the Kentucky Health Benefits Exchange, which the state has branded as Kynect, partly to avoid identification with the pejorative nickname Obamacare. She shares the credit for its success.

I've been too busy with my day job (I do have one, you know...) to post much lately, but plenty of ACA-related news has piled up, so I'm clearing off my desk with some quick bits:

MARYLAND: An Amazing Healthcare Revolution Is Happening In Maryland — And Almost No One's Talking About It

The Maryland ACA exchange has been one of the "middle-tier" models in my view; not an utter disaster like the ones in Oregon or Massachusetts, but still riddled with technical problems like the ones in Minnesota & Vermont. However, the state has apparently had a different healthcare-related initiative which has been a huge success so far:

Through innovative methods and a data-centric approach, Western Maryland Regional Medical Center, has become the cornerstone in Democratic Gov. Martin O'Malley's ambitious makeover of the state's healthcare programs.

I've been too busy with my day job (I do have one, you know...) to post much lately, but plenty of ACA-related news has piled up, so I'm clearing off my desk with some quick bits:

ARKANSAS:

Mark Pryor shows Democrats how they should campaign on the Affordable Care Act in a red state. You don't have to mention Obamacare (which technically doesn't even exist), you don't have to even mention the Affordable Care Act. You do have to personalize what the law actually means forreal people with real medical issues which were fixed or improved by the law:

It gets a bit involved, but her conclusion is that yeah, it probably has been cut significantly, but a specific percent number is hart to pinpoint since there's still a lot of noise on the ESI side as well as continuous churn across the board as people move on & off of different plans.

However, it does include a few nuggets which help me update my own data. For one thing, CT's SHOP enrollment has gone up from 500 as of February to a whopping...602 people last month:

Access Health also operates an exchange for small businesses, although uptake has been low. As of mid-July, it covered 602 people.

"Republicans seeking to unseat the U.S. Senate incumbent in North Carolina have cut in half the portion of their top issue ads citing Obamacare, a sign that the party's favorite attack against Democrats is losing its punch," Bloomberg reports.

"The shift -- also taking place in competitive states such as Arkansas and Louisiana -- shows Republicans are easing off their strategy of criticizing Democrats over the Affordable Care Act now that many Americans are benefiting from the law and the measure is unlikely to be repealed."

I haven't posted much the past few days, partly because of a lack of major ACA news, partly because I'm busily playing catch-up with my day job (I do have one, believe it or not), and partly because all the oxygen has been (rightly) sucked out of the news atmosphere the past week or so by the slow-motion trainwreck called "Ferguson, Missouri".

So, I was a bit surprised to see my name and this site figure heavily as a source by Megan McArdle over at BloombergView, in an article called "More Bad News for Obamacare". McArdle has decided to pick up the "Massive Attrition!!" ball which I debunked last week and run with it, citing me as a source several times (including using me as her source for the news of the HHS Dept. dropping off-season enrollment reports)...and yet completely ignoring my entire point:

on net, they expect enrollment to shrink from their March numbers by a substantial amount -- as much as 30 percent at Aetna Inc., for example.

A couple of weeks ago, I posted about how insurance providers in Connecticut requested rate changes ranging up to 12.8%...but the approved rate increase, overall, appeared to only be around 4.5% when weighted by market share. However, that was based on the assumption that the largest provider, Anthem BCBS, would end up with an approved average of around a 6% increase.

Today, it was revealed that Anthem's actual rate changes for 2015 will be an average of 0.1% lower:

Anthem, the state’s largest insurer, initially requested approval to raise rates by an average of 12.5 percent. But the insurance department rejected the proposal and asked the company to resubmit its plan using different calculations.

The result: An average premium decrease of 0.1 percent for Anthem customers.

This is a classic case of one's attitude determining whether this is good or bad news. The headline and lede make a huge deal about 400,000 people having to re-enroll in the Massachusetts ACA exchange this winter...except that I've been pushing hard for everyone to be required to re-enroll once per year anyway regardless of whether their personal incomes/circumstances have changed over the past year or not...which means that to me, it's not only not a big deal that everyone in MA will be required to re-enroll, but it's actually a good thing:

Nearly 400,000 people in Massachusetts will need to reapply for health insurance before the end of the year, and many of them probably do not even know it.

They are people who do not have employer-sponsored health insurance and who instead sought insurance through the state. After the Massachusetts insurance website failed last year, most of them were enrolled in temporary coverage that ends Dec. 31, which is why they must select a new plan.

While the technical overhauls/transfers of exchanges in states like Oregon, Nevada, Massachusetts and Maryland have been taking up all of the "ACA tech problem" news (the former two are moving to HC.gov for 2015; the latter two are completely overhauling their own websites), Hawaii's technical woes seem to always have operated in something of a news vacuum. The Hawaii website problems were always just as bad as some of the other states listed, yet not once have I received any indication of whether they were abandoning their software like OR & NV or fixing it like MA & MD.

Over the past couple of weeks, the answer seems to have revealed itself: The Hawaii Health Connector website has been revamped...as a WordPress-based site. However, this appears to only be the "welcome/info" portal; actually clicking the "Enroll" links takes you to a different domain name at ConnectHawaii.com which seems to be the actual HI exchange.

Not a lot of news this week as the whole country seems to be transfixed by the shooting death of Michael Brown and the insane overreaction by the police in Ferguson, Missouri (as well as the deaths of legends Robin Williams and Lauren Bacall).

However, Minnesota continues to quietly crank along, adding 141 people to the QHP tally and 4,748 to Medicaid in just the past 3 days:

On the other hand, in a weird sort of way it has everything to do with it.

Last night, the town of Ferguson, Missouri turned into a warzone. I've never seen anything like it...at least here in the U.S. A few days after police gunned down an unarmed black teenager (possibly shooting him in the back) and the refused to release the name of the officer who shot him, I watched live video of the St. Louis County PD very much unallegedly demanding that the news media turn off their cameras, fire tear gas and rubber bullets into an unarmed, fairly peaceful crowd and people's yards and generally terrorize the very populace that they're supposed to be protecting.

And in the middle of this utter mess, White House Principal Deputy Press Secretary Eric Schultz decided it was the perfect time to tweet the following:

Readout of tonight's social gathering coming shortly - spoiler alert: a good time was had by all.

...One of the scariest claims was that premiums were going to shoot up because only the sick and the old would sign up. The danger, of course, was that this would set off the so-called death spiral, where high prices prompt people to drop their coverage until eventually the whole project collapses in failure and shame.

...Here we are five months later, and those insurance officials have begun reporting their premium increases for next year. To put it mildly, those increases do not seem to fit the definition of “skyrocketing."

...The average national increase of 7.5 percent is “well below the double-digit increases many feared,” [PwC] HRI Managing Director Ceci Connolly wrote in ane-mail.

Needless to say, this is quite a bit different than the scenario the Hill laid out in March. A 7.5 percent average increase is somewhat smaller than the 100 percent increase the newspaper was predicting only five months ago.

The only caveat here is that the 7.5% average only covers 27 states; according to PwC researcher Caitlin Sweany, the overall average is actually a bit higher:

I just received a press release from the Centers for Medicare & Medicaid Services (the HHS division which actually operates the federal ACA exchange). The short version: Out of around 970,000 citizenship/immigration data matching issues as of May, they've managed to successfully resolve 450,000 of them and are in the middle of processing another 210,000.

Unfortunately, this means that 310,000 people still have their status in limbo, so they're re-contacting all of them by mail to resolve whatever their issues are by the end of September, or they'll have their policies cut off:

Administration has closed approximately 450,000 citizenship and immigration status data matching cases and another 210,000 are in progress; warns remaining consumers to respond quickly or their Marketplace coverage could end

ObamaCare exchange statistics should clear up any doubt as to why the Obama Administration has been tight-lipped about enrollment since celebrating 8 million sign-ups in mid-April.

Reality, evidence suggests, could require quite a come-down from those lofty claims.

The nation's third-largest health insurer had 720,000 people sign up for exchange coverage as of May 20, a spokesman confirmed to IBD. At the end of June, it had fewer than 600,000 paying customers. Aetna expects that to fall to "just over 500,000" by the end of the year.

Yup, on the surface that does look pretty bad. Or, at least, it would, if a) that was representative of the trend as a whole and b) if I hadn't already addressed the "attrition" factor several times in the past.

OK, I still have to plug the numbers into the spreadsheet, but here's the major takeaways:

Across the 49 states (including the District of Columbia) that provided enrollment data for June 2014, states reported that approximately 66 million individuals were enrolled in Medicaid and CHIP. [actual: 66,112,314]

602,210 additional people were enrolled in June 2014 as compared to May 2014 in the 49 states that reported both June and May data.

...approximately 7.2 million additional individuals are enrolled in Medicaid and CHIP, a 12.4 percent increase over the average monthly enrollment for July through September of 2013.

Among states that adopted the Medicaid expansion and whose expansions were in effect in June 2014, Medicaid and CHIP enrollment rose by over 18.5 percent compared to the July- September 2013 baseline period, while states that have not, to date, expanded Medicaid reported an increase of approximately 4 percent over the same period.

These enrollment counts are in addition to the enrollment increases from the nearly 950,000 individuals who gained coverage as a result of the Affordable Care Act before open enrollment began. Seven states implemented an “early option” to expand Medicaid coverage to adults with incomes up to 133 percent of the FPL between April 1, 2010 and January 1, 2014, using new state plan authority provided by the Affordable Care Act or a Section 1115 demonstration building upon that authority.

When we last checked in on Arkansas, they had enrolled 185,000 people in their unusual "Private" Medicaid option program via the ACA. That number has since grown to over 192K:

According to the latest information released by the Department of Human Services today, 192,210 Arkansans have gained coverage via the private option, the state's unique version of Medicaid expansion which uses Medicaid funds to purchase private insurance for low-income Arkansans. This includes both beneficiaries enrolling in a private plan and those deemed medically needy and routed to the traditional Medicaid program (around 11 percent of the total).

In this case it's important to note that these folks have actually gained coverage already. That is, this doesn't include people still "in process" etc. With appx. 225,000 Arkansans eligible for the program, that means AR has reached over 85% of the total possible.

OK, I can't embed the video and even the link above just goes to the general Hardball video archive page, but on MSNBC's Hardball this evening, Kentucky Governor Steve Beshear gave an updated total for ACA enrollments via the Kynect exchange: 521,000 Kentuckians. The exact quote, about 2 minutes into the segment:

“The numbers speak for themselves...from the time we opened up our healthcare exchange on October 1 at 12:01am, Kentuckians started swarming all over that website, and today, 9 months later, 521,000 Kentuckians, almost 1 in 10 Kentuckians have signed up for affordable healthcare coverage.”

He repeated the 521K number not once more but twice; obviously this was the key talking point he wanted to emphasize. Unfortunately, as has been typical for Kentucky since the end of open enrollment, he didn't break out QHPs from Medicaid/CHIP enrollments.

Chris Conover and I have developed a sort of grudging respect for each other. This evening he asked me why I use a blanket "90% Paid" estimate for the states for which I don't have any hard data, instead of running a weighted average of the data I do have and using that. This is a fair question.

I partially answered it in an entry from about a week ago, in which I noted that if you average the numbers for the 18 states which have provided at least 1 payment rate update since the end of open enrollment:

...Add all of these up and you get a total of out of 2.542 million out of 2.932 million, or 87%...and again, take a look at how out of date most of those numbers are (especially California, which makes up almost half of the total, yet hasn't been updated since April 21st...a solid 9 days before hundreds of thosuands of their policies even started coverage!).

Once again, I'm quite confident that the true eventual number is around 90%.

Yes, I'm quoted extensively in this CNBC piece by Dan Mangan, and yes, I rip on the HHS Dept. quite a bit in it (towards the end) for their continuing failure to issue monthly ACA enrollment reports during the off season. However, in terms of actual new enrollment data, there's a bit earlier in the story which caught my eye:

...at least 10 of those [state-run] exchanges have disclosed, at some point, how many people have paid their first month's premiums.

For example, a spokeswoman for Colorado's exchange, in a statement to CNBC, said: "As of June, we received data from the health insurance carriers that show 89.9 percent of Coloradans who purchased private health insurance through Connect for Health Colorado paid their first-month premium. There is some lag in data, so we anticipate that percentage may actually be higher ... we obtain this data from each of our 17 carriers and anticipate more complete information as we move forward."

Access Health CT, the state-run onlinehealth insurance marketplace created under the federal Affordable Care Act, has enrolled more than 256,000 state residents in private health plans or Medicaid since the website launched last fall.

The open enrollment period total of 218,100 (including everything through 4/19) broke out roughly 36:64. Assuming "more than 256K" is roughly 256,100, that means about 38,000 more people since then. If that ratio has stayed consistent, it should be around 13,700 QHPs and 24,300 Medicaid. However, as I noted the other day, with off season enrollment being limited for QHPs but open-ended for Medicaid/CHIP, the ratio has almost certainly shifted substantially in Medicaid's favor.

Hmmm...another unusual slowdown for Oregon; total QHPs are only up 873 since 7/28, and net QHPs are actually down 63, presumably due to purging of unpaid enrollments and cancellations of existing policies. Medicaid enrollments, meanwhile, are up another 499.

As an aside, I also question the wisdom of not requiring everyone to re-enroll each year. Obviously HHS is trying to minimize the inconvenience/hassle factor, but it seems to me that this is just going to cause even greater confusion than it would if they simply issued a blanket statement: If you enrolled via an ACA exchange, you have to renew once a year even if nothing else has changed.

I don't see doing this as a big deal; people have to renew their license plates every year even if it's for the same car, for example. They don't have to make it that complicated...just have big Yes/No radio buttons once you log in that says "Have you had any significant changes in (income, dependents, etc...provide a list) since (date of existing policy enrollment)?" If no, then you click "Save" and you're done. If yes, then you go ahead and make whatever changes are necessary.

Yesterday, the Big News on the ACA front was a new state-by-state survey from Gallup which showed the overall impact to date on total uninsured rates across the country.

Not surprisingly, the main takeaway, as noted by Jeffrey Young over at the Huffington Post, is that states which have embraced the law (Medicaid expansion, their own exchanges) have done a much better job overall of reducing their uninsured numbers than those which shunned it.

It's an interesting survey and an interesting piece, complete with a color-coded map which shows how the different states have fared (although I really wish they'd used higher-contrast colors; it's hard for me to distinguish some of the ranges from others).

However, there's one state which really stands out to me, and it's smack in the center: Kansas.

Yesterday I put out an open call for off-season QHP data from California, New York and Rhode Island, none of whom have released this info since 4/19 (Connecticut hasn't either...they gave me their combined total for QHPs + Medicaid, but I can't use that for a proper projection until I know the actual breakout between the two).

Today, thanks to Dara Chadwick of HealthSourceRI, I can cross Rhode Island off the list:

We had 25,767 total paid QHP enrollments during the open enrollment period, including all individuals who enrolled by March 31 and paid by April 23.

As of August 2, 2014, 26,686 Rhode Islanders are enrolled in QHPs. Of those, 25,892 have paid.

OK, I'll have to reverse engineer things slightly here, since the paid number is given for both August 2nd and March 31st, but the total number is only given for August 2nd. Looking back at my last entry for Rhode Island, the 3/31 total was 27,968.

NOTE: I originally posted this as an update to my Florida rate increase entry this morning, but it's important enough that I figured I should repost it as a separate entry.

Thanks to Caitlin Sweany of PricewaterhouseCoopers for explaining an interesting discrepancy I noted in at least one state (my own state of Michigan). This is another example of how difficult it is to nail down the actual impact of these rate changes (and remember, in many cases these are still just requests, not approved rates, subject to change). Case in point:

A couple of caveats: This report from private online insurance broker eHealth Insurance a) only reflects off-exchange enrollments, b) only includes people who enrolled through their brokerage, not directly via the companies themselves, and c) is, frankly, kind of difficult to actually read as presented, but contributor Esther F. noted an important section:

Outside of open enrollment, health insurance shoppers may only be able to purchase individual and family major medical coverage when they experience a qualifying life event such as marriage, divorce, the birth of a child, the loss of employer-based health insurance, etc. A June 2014 analysis of eHealth shoppers has shown that nearly half (49%) of those who reported a qualifying life event selected "loss of coverage" as the qualifying life event which they had experienced. More than one-in-ten (11%) indicated that they had moved to another city or state, while six percent (6%) indicated that they were recently married or divorced and three percent (3%) reported the birth or adoption of a child.

Floridians who buy health insurance on the individual market for next year will face an average increase of 13.2 percent in their monthly premiums, according to rate proposals unveiled Monday by the state’s Office of Insurance Regulation.

Of the 11 returning plans, eight filed average rate increases ranging from 11 to 23 percent, and three filed rate decreases ranging from 5 to 12 percent, the state’s insurance regulator reported.

Things are slowing down now, but Michigan continues to slowly, gradually add to the Medicaid expansion tally. With appx. 500K people estimated to be eligible for the program, they've now hit 69% of that number.

Healthy Michigan Plan Enrollment Statistics

Beneficiaries with Healthy Michigan Plan Coverage: 345,533
(Includes beneficiaries enrolled in health plans and beneficiaries not required to enroll in a health plan.)

However, there are several states whose data has eluded me so far...and unfortunately, this includes the two largest state-run exchanges: California and New York. I've contacted both exchanges; CoveredCA told me that updated enrollment numbers would be released "soon" but that was a good month ago. The New York State of Health exchange flatly stated that they, like HHS, would not be giving out any sort of official off-season enrollment update. There's also the Rhode Island exchange, which hasn't responded to my requests at all. (Update: Never mind that last one; just heard directly from the RI exchange, hopefully they'll be able to provide an update soon...)

They weren't able to provide a breakdown between private QHPs and Medicaid/CHIP enrollment, but I can make a pretty good guess.

According to the final HHS report, Connecticut's official exchange QHP total as of 4/19 was 79,192, and Medicaid determinations were 138,908, for a combined total of 218,100. Since then, this total has gone up 32,533. The QHP/Medicaid ratio during open enrollment was roughly 36/64, which, if consistent during the off season would mean around 11,700 more QHPs to around 20,800 Medicaid enrollees.

With the recent conflicting rulings by federal courts over whether subsidies for health insurance can be used by residents in states relying on the federal health insurance exchange created by the Affordable Care Act, there is discussion of revisiting the creation of a state-run exchange in Michigan.

The key significance here is that unlike, say, Delaware or Illinois which have Democratic administrations/legislatures but still chose to stick with Healthcare.Gov until now, Michigan's government is currently completely controlled by Republicans...yet even they seem to be coming around to the reality that the ACA, for all of its flaws, is actually working pretty damned well so far:

Republican Jim Marleau chairs the state Senate Health Policy Committee. He says the federal health exchange has worked well for Michiganders since problems with the website were fixed late last year. But he says he’s still interested in a state-run exchange – especially if issues pop up again.

Hmmmm...ok, yesterday I reported that "over 37,000" Nevadans had fully enrolled & paid for QHPs to date, based on a story in the Las Vegas Sun. Today, a similar story over at KTNV (ABC Channel 13) gives the estimated number as 38,000, about 900 higher than the 38.1K I figured yesterday. Everything else is pretty much the same.

The couple is among an estimated 38,000 Nevadans who purchased plans through the health link website but will have to re-enroll between Nov. 15 and Feb. 15 because of the state's switch from Xerox to the healthcare.gov.

Oregon is, I believe, the 5th state to release their approved ACA exchange premium rates for 2015, after Rhode Island, Connecticut, California and Mississippi. Like most of the others, it's a mixed bag, with some companies raising their rates by up to 10% but others reducing theirs by as much as 20% (or even 26% for the small group market, although that's not the one that I'm primarily looking at).

About 80,000 Moda Health members who buy their own insurance will see their monthly premiums climb an average 10.6 percent next year, while many other insurers are dropping their rates to compete.

Insurance rate decisions were issued by the Oregon Insurance Division Thursday and announced today, showing a tighter range of premiums in the individual market for people not covered by employers or Medicare.

Moda's once market-leading rates have jumped to middle of the pack. For a silver plan, a 40-year old in Portland can find four insurers with lower premiums approved by the state.

Until this month, Maryland's reports were a bit irritating in two ways: First, they were running a month behind; second, the "thru dates" for the QHP numbers never quite lined up with the Medicaid number for some reason. With today's report, they've corrected both issues, bundling both June and most of July in and matching up the dates:

Enrollment DataAs of July 26, 2014, 332,504 individuals have gained Medicaid coverage in 2014 and remain active in Medicaid. This includes the 95,889 PAC enrollees who were automatically converted on January 1, 2014 to full Medicaid coverage.

Beginning this month, we will also report net changes in Medicaid enrollment. This figure takes into account the fact individuals lose Medicaid coverage because of changes in household, age, and income, as well as redeterminations. Compared to December 31, 2013, the net change in Medicaid enrollment as of July 26, 2014 is +273,245.

As of July 26, 78,930 individuals have enrolled in a qualified health plan.